What Is Sundown Syndrome In the Elderly?

Senior Sundown Syndrome: Understanding the Causes, Signs, and Tips for Helping Elderly Loved Ones Age With Dignity

If you’re a caretaker for someone with Alzheimer’s disease or dementia, you may notice some significant changes in their behavior beginning in the late afternoon or early evening.

They might experience confusion, agitation, or mood swings. They may become disoriented or unusually demanding … all signs of sundowner’s syndrome in seniors. 

Research shows that 20 to 45% of people suffering from Alzheimer’s will experience at least some level of sundown syndrome. 

If you want to better understand senior sundown syndrome, we can help. Keep reading to learn about sundowner’s syndrome in the elderly and what you can do to give your loved one the support they deserve.

What Is Sundown Syndrome in the Elderly? 

Sundown syndrome, also known as benign sundowning or sundowners, refers to a time of confusion that may occur in elderly dementia patients from the late afternoon into the nighttime hours.

Elderly sundowning syndrome can cause a variety of behaviors, such as:

• Confusion

• Disorientation

• Anxiety

• Suspicion

• Making excessive demands

• Aggression 

• Agitation

• Irritability 

• Restlessness

• Pacing

• Wandering; and

• Ignoring directions

A person experiencing senior sundown syndrome may also:

• Yell

• Have mood swings; or 

• See or hear things

Sundown syndrome in the elderly may be triggered by a wide variety of factors, including: 

• Fatigue

• Hunger or thirst

• Low lighting

• Spending a day in an unfamiliar place

• Increased shadows

• Being in pain

• Disruption of their “internal clock”

• Difficulty separating reality from dreams

• An infection, such as a urinary tract infection

• Being bored

• Depression

How Long Does Sundowning Last?

Sundown syndrome may appear during the middle and later stages of Alzheimer’s disease and can be displayed as long as triggers continue.

The symptoms of sundown syndrome in seniors typically start between 4:30 in the afternoon and 11:00 at night.

They generally develop as daylight begins to fade and may progressively worsen as the day draws to a close. Sundown syndrome usually occurs around the same time of day for each individual and lasts for several hours.

Thankfully, sundowners syndrome in seniors is typically a phase, and most seniors eventually revert to normal once the spell has run its course.

What Causes Sundown Syndrome in the Elderly?

The causes of senior sundown syndrome aren’t clear. 

It’s possible that Alzheimer’s-related changes in the brain affect a person’s internal “biological clock.” These changes may lead to the progressive confusion of sleep-wake cycles. 

Exhaustion caused by the lack of sleep that accompanies sundowners syndrome only serves to exacerbate the problem.

Senior sundown syndrome may be more likely in older adults who are:

• Overly tired

• Depressed

• Lacking mental stimulation

• Hungry or thirsty

• In pain

• Easily disoriented; or

• Having sleep problems

What Are the Early Signs of Sundowners?

Signs of sundown syndrome in seniors may include:

• Restlessness

• Irritability

• Disorientation

• Anxiety

• A decline in physical activity

• An increase in sleepiness during the day

• Difficulty falling asleep and staying asleep

• Suspicion

• Demanding behaviors

• Decrease in overall well-being

• Agitation; and 

• Mental confusion at night

As elderly sundowning syndrome progresses, the symptoms may become increasingly pronounced. At times, they may even develop into more serious behavioral disturbances such as:

• Emotional outbursts

• Extreme agitation

• Verbal aggression

• Physical assault

• Destruction of property

• Paranoia; or 

• Hallucinations

6 Tips to Manage Sundowners Syndrome in the Elderly

There are a few things you can do to help your loved one avoid senior sundown syndrome, including:

• Maintaining comfortable, familiar surroundings

• Adjusting light exposure 

• Minimizing nighttime stressors

• Keeping an eye out for triggers

• Encouraging regular exercise throughout the day; and 

• Sticking to a regular routine

#1: Keep Surroundings Comfortable & Familiar

For dementia patients, once-normal surroundings can become scary places.

Familiarity and comfort can provide reassurance and make coping with senior sundown syndrome as easy as possible.

Keep your loved one’s home and life filled with things they find comforting. If they are in an assisted living community, furnish the surrounding space with their most cherished items, such as:

• A favorite blanket; and

• Family photos

They may prefer to be in certain rooms of their home or apartment or choose to sleep in a different bed or room that feels familiar and safe. 

Night lights are also a helpful addition to the bedroom, bathroom, and hallway in case they need to get up in the middle of the night. This can help minimize confusion and disorientation during bouts of sundowners syndrome in elderly people.

#2: Adjust Light Exposure

Sundown syndrome in seniors may be aggravated by changes in their circadian rhythms or their sleep-wake cycles.

This can be a particular problem as winter approaches and the daylight hours become shorter.

A 2011 study revealed that light therapy may help reduce confusion and agitation in individuals suffering from dementia. 

Adjusting the levels of light in the home may help reduce symptoms. One suggestion for light therapy is placing a full-spectrum fluorescent light 3 feet away from your loved one for a few hours each morning. Turning on outside lights in the early evening may also help.

#3: Minimize Nighttime Stressors

Another suggestion for battling senior sundown syndrome is to help your loved one remain calm during the evening hours.

Stress and frustration only add to their irritability and confusion. Try to encourage them to focus on simple activities that aren’t overly challenging or frightening. 

A 2018 study found that senior adults are more sensitive to noise, so avoid excessive activity and large groups of people, if possible. 

For some with mid- or advanced-stage dementia, even reading a book or watching television in the evening may be too much. Instead, they may enjoy … 

• Having you read aloud to them

• Snuggling a pet

• Looking at photographs from the past; or

• Listening to soft music

#4: Watch For Triggers 

Certain environments and activities may trigger sundowners syndrome in the elderly.

Triggers can be different from individual to individual and may include things such as:

• Fatigue

• Loud noises

• Stimulating activities, including watching TV

• Discomfort

• Dark or unfamiliar surroundings

• Stressful activities; or

• Changes in surroundings or caregivers

Keep track of what triggers or worsens symptoms so you can help avoid those situations that lead to agitation and confusion.

If triggering does take place, do your best to redirect and calm the individual and move to a more relaxed, familiar setting.

#5: Get Regular Exercise Throughout the Day

Many seniors with sundown syndrome have trouble sleeping at night. As a result, they often suffer from extreme fatigue. This vicious cycle only serves to worsen sundown syndrome’s effects.

One way to combat the problem and help ensure a good night’s sleep is to encourage regular exercise throughout the day.

Many elderly patients with dementia are left to excessive daytime dozing. 

But this type of inactivity can make it harder for them to fall asleep at bedtime. To help them sleep well at night, try to keep them active throughout the day with activities such as:

• A trip to the mailbox

• Walking to meals

• A stroll around their yard or a nearby park

Not only will this movement help reduce their restlessness and help them sleep better, but it can also: 

• Give them exposure to natural sunlight

• Maintain mobility; and

• Provide life-giving fresh air

#6: Develop a Regular Daily Routine

For individuals suffering from dementia, it can be difficult to develop and remember new routines. 

A 2019 study found that a lack of routine can lead to symptoms of depression in older adults. Unfamiliar places and things can be met with feelings of confusion, stress, and anger. These feelings can have a big impact on senior sundown syndrome.

Predictability is key. Do your best to have set times for daily activities, such as: 

• Waking

• Meals

• Exercise

• Bath time; and

• Any away-from-home activities

This will help minimize opportunities for confusion and foster an internal sense of calm and security. 

If you find it necessary to make changes to the daily schedule, try to do so as gradually as possible.

A regular daily routine that minimizes surprises will help your loved one feel safe and reduce confusion and anxiety.

Senior Services of America: Helping People With Dementia Age With Dignity

Senior Services of America, offers specialized memory care communities that are intimately familiar with each stage of Alzheimer’s and dementia.

We strive to support the physical, emotional, and social needs of seniors with dementia as well as  empower them to maintain their independence and continue living as normally as possible — while offering assistance when it is needed.

Our goal is to provide our residents with a positive experience every day through life-enriching care and the best possible customer service.

When you’re ready to learn more about our memory care communities, we’re here to help you explore the options.

Find your nearest Senior Services of America community today.